THE ROLE OF DEVELOPMENTAL POSITIONING IN NEONATES

K F Lyons

Preterm Neonate

Congenital Abnormalities

5% of Neonates 95% Survive

Evidence to support developmental delay in Surgical Neonates with normal neurology

Laing S et al (2011). Early development of children with major birth defects requiring newborn surgery.

Journal of Paediatrics and Child Health. 47:140-147

118 infants with congenital abnormalities following surgery during the neonatal period

26% had motor delay, 20% global delay

Newborn• Physiological flexion• Protraction of

shoulders and posterior pelvic tilt

• Vital for development of normal body movement and control

Surgical neonate

• Ventilated• Sedated for long

periods• Muscle relaxed

Muscle weakness

Muscle imbalance• Take up surface • Lack of movement

against gravity• Stay where placed• Poor co-contraction• Head turning

preference• Poor feeding pattern

Developmentally delayed

Evidence of low central stability

Danser E et al (2013).Preschool neurological assessment in congenital diaphragmatic hernia survivors: Outcome and

perinatal factors associated with neurodevelopmental impairment. Early human dev.

89: 393-400.

CDH survivors 22% motor delay, additional 14% severe delay.

Hypotonicity was found in 33% of patients

Postures

Risk factors• Low birth weight• Critical illness• Multiple surgery• Ventilation time• Prolonged oxygen

requirement• Poor nutrition• Interrupted sleep

patterns • Prolonged

hospitalisation

Positionally and Environmentally Challenged

Extended

Floppy

Asymmetrical

• Head turning preference

• Plagiocephaly• No midline

development• Poor communication

Current Practice

Support in flexion

Positioning Aids

Z-Flo/ Tortoise

The Leckey Infant Positioning System (IPS)

Enhanced supine support

• Greater amount of containment

• Consistent flexion• Mechanical

advantage abdominals

Audit of infants requiring additional support

Poddle pod

Problem solve

Minimise abnormal postures for maximum function

• No midline development

• No self consoling• Affecting vision and

communication• Inhibiting skill

acquisition• Contracture formation

Unsupported v supported

Enable midline and symmetry

Support in consistent flexion

Support in consistent flexion

Additional support

Contain and inhibit

Additional support

Contain and inhibit

Head turning preference

Orthopaedic problems

Risk assessment

• Environment

• Support required

Check equipment

• Support when needed and allow for difficulties

Normalise Handling

Facilitate movement

Be inventive

Minimise Risk

Thanks for Listening